Basic Information
| Provider Information | |||||||||
| NPI: | 1730334889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICCITELLI | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | MICHELLI | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS,RD,LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 RIDGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MARY ESTHER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325692711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506854187 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 MAR WALT DR | ||||||||
| Address2: | |||||||||
| City: | FT WALTON BCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508621111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2008 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND5252 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.